Saturday, March 14, 2015

Insuring quack medical treatments and non-quack useless treatments

A few years ago I had an arthroscopy in my right knee. It followed acute knee pain that resulted from clumsy attempts to climb a locked gate at the Western Treatment Plant. The pain was intense and "burning" - it lasted several weeks while my GP suggested I rub Voltaren on it which had no effect at all. Finally I went to a "sports doctor" who recommended arthroscopic knee surgery. I was on crutches for a couple of weeks after which the knee went back to normal, the pain gone I think permanently.

I was intrigued therefore to read in this morning's AFR ("Rolfing and Rebates", unfortunately pay-walled) that some insurers (NIB) regard arthroscopies as being ineffective so that, like Rolfing, homeopathy, naturopathy, massage and herbalist treatments (and other evidence-free medical practices) insurance companies should not provide cover for them.

I am not expert on medical issues but I wondered if the claim with respect to arthroscopy is correct true. This article posted online claims they are. It claims the recovery I experienced would probably be achieved by a placebo procedure.

Two issues occur to me:

(1) Should insurance companies provide cover for treatments that consumers demand - if- like homeopathy - there is no clinical evidence they work. One insurer in the AFR answered "yes" to this question since insurance companies should reflect consumer preferences and, presumably, not science. I have problems with this view since providing insurance cover to procedures signals to customers that the procedures are valid. By reducing the effective cost they also increase incentives to use them.

(2) How many more mainstream "respected" treatments (like arthroscopy) are being insured even though there is little clinical evidence they work? I wonder, for example, about the widespread advocacy of Statin drugs for dealing with claimed cholesterol problems: See here - Statins of concern to me as I have taken these drugs for a decade. Or the now discredited, but still practised, advocacy of a carbohydrate-based "food pyramid" that has driven millions into obesity, Type 2 diabetes and heart disease. Ditto the rejection of carbohydrate intake as a treatment for diabetes and obesity.

4 comments:

These days after a visit to the doctor I usually have a look at a relevant Cochrane Collaboration (http://www.cochrane.org/) metareviews. It is most enlightening; quite simply it appears that an awful lot of treatments just don't work. Given that, it seems much of conventional medicine is only one step up from quackery (though of course "alternative" medicine has not even made that one step).

I rue my (expensive) experiences with a 'frozen shoulder', involving popping the area with compressed air etc at a supposed highly regarded sports medicine clinic. NO change. Just got over our GP telling my wife she had a ganglia in her wrist... I queried how this would cause a skin infection... No reply... Advised to come back in two weeks. After one treatment with diprosone (my treatment for my for skin Psyrrosis) there is no sign of infection and of course, no ganglia..

Norman Swan on the ABC Health Report did a show on exactly this issue. Basically, this is one of the few cases where surgery was subjected to the standard double blind testing. Patients actually had fake operations where they were anaethsitised and cut open and sewed up again.

The conclusion was that there was no difference between those who had the real op and those who didn't.

The other study of this type that I found interesting was that broken bones healed better if the patient did not have any sort of claim (e.g. motor vehicle insurance, workers comp etc) for the injury. So provided its just your own fault, you'll get better quicker.